Short staffed Durban clinic raises question: What is the cost of waiting?

DURBAN, SOUTH AFRICA— No one knows the cost of waiting better than the people of South Africa where government denial that HIV causes AIDS set back an appropriate response, including provision of life-saving medicine, by a decade at a cost of at least a third of a million lives. On the outskirts of Durban, in the South Africa province of KwaZulu-Natal — with an estimated HIV prevalence exceeding 22 percent, often referred to locally as “the epicenter of the epicenter” of the AIDS epidemic — St. Mary’s Hospital started supplying antiretroviral treatment when the U.S. President’s Emergency Plan For AIDS Relief began. Today, with PEPFAR funds, it has put 12,000 people on treatment. But with the South African government’s long-delayed commitment and investment South Africa now is on a fast-track to be the first PEPFAR country to go through the program’s planned “transition” to “country ownership” that will include “technical guidance.” All of these terms are in quotation marks because here, where no precedent exists, they remain loosely defined. At the hospital’s Mpola Clinic, a harried head nurse told us, it means training and mentoring that the short-staffed facility can ill-afford to take advantage of. The facility was down to one nurse the day we visited, while patients filled halls, waiting rooms, and clinic grounds waiting to be seen, with areas for acutely ill children, patients with mental disabilities, and sick patients yet to be diagnosed overlapped. And with a projected wait time of half a day or more, staff raised questions of how long patients could pay the opportunity costs of missing work and family obligations to tend to their health. Which in turn raised the question of what the cost of waiting, once again, would be this time.